Ulcerative Colitis

Ulcerative Colitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Chronic relapsing and remitting inflammatory disease of the bowel causing recurrent episodes of diarrhea that is often bloody and accompanied by abdominal pain, incontinence, fever, and weight loss
  • Marked by inflammatory colonic mucosal changes
  • Colonic involvement is universal but may be accompanied by large joint arthritis, ocular inflammation, skin lesions, biliary disease, liver disease, thromboembolic disease, and (rarely) pulmonary complications.

Epidemiology

Incidence
  • North America: 19.2/100,000 person-years (1)
  • Europe: 24.3/100,000 person-years (1)
  • Asia/Middle East: 6.3/100,000 person-years (1)

Prevalence
  • North America: 249/100,000 persons (1)
  • Europe: 505/100,000 persons (1)
Pregnancy Considerations
  • Increased risk of preterm delivery and small for gestational age birth
  • 30% with inactive disease relapse in pregnancy
  • Management with gastroenterologist and/or maternal–fetal medicine specialist/obstetrician is recommended.

Etiology and Pathophysiology

  • Idiopathic; hypothesized association with autoimmune dysfunction, genetic predisposition, diet, and colonic microbiome
  • Almost universally involves terminal colon, >95% of patients have rectal involvement, 50% have disease limited to rectum and sigmoid; 20% have pancolitis.

Genetics
Moderate heritability. Specific genetic markers have not been identified.

Risk Factors

  • Age: variable, peak incidence among ages 15 to 40 years
  • First-degree relative with ulcerative colitis (UC)
  • Theorized risk factors include disruption of colonic microbiome by diet or infection, dietary factors (Western diet in particular), antibiotic use, lack of breastfeeding in infant, obesity, and NSAID use.

General Prevention

No known preventive measures

Pediatric Considerations
  • Breastfeeding may protect against pediatric inflammatory bowel disease (IBD).
  • UC more likely pancolonic at onset and shorter time from diagnosis to colectomy (median 11 years)

Commonly Associated Conditions

  • Arthritis: large joint, sacroiliitis, ankylosing spondylitis
  • Pyoderma gangrenosum (rare)
  • Erythema nodosum (common)
  • Aphthous ulcers
  • Episcleritis and uveitis (rare)
  • Autoimmune liver disease (rare)
  • Fatty liver (common)
  • Liver cirrhosis (rare)
  • Primary sclerosing cholangitis (rare)
  • Bile duct carcinoma (rare)
  • Thromboembolic disease (rare)
  • Colon cancer (rare)
  • Anemia (rare)
  • Pulmonary diseases (very rare)

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